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Lee County/NACO Jail Diversion Grant Shows Success
Jan 25, 2006 FOR IMMEDIATE RELEASE Contact: Ann Arnall, Lee County Human Services, 533-7920 LEE COUNTY/NACO JAIL DIVERSION GRANT SHOWS SUCCESS The Pre-Trial Outreach Project was intended to educate and train those in the justice system's Pre-Trial Services to proactively identify individuals with a mental illness coming into the court system and divert them to treatment programs. Measurable goals of the Pre-Trial Outreach Project included: Demonstrate a minimum of two (2) diversions per month. Incorporate Pre-Trial Services representation into the Forensic Mental Health Advisory Council. Ongoing, informal training of Pre-Trial Services personnel (documented by liaison) related to mental health services and diversion concepts/opportunities. Completion of formal training for Pre-Trial Services personnel (minimum of 2 formal trainings over course of grant year) related to mental health services and diversion concepts/opportunities. In collaboration with the Forensic Mental Health Council, develop a long-range diversion plan, including plans for sustaining existing diversion efforts and expansion of diversion activities. Attached is the final report on the results of the project indicating 26 individuals were served. The grant funding was provided by Eli Lilly and Company through NACo. The Forensic Mental Health Advisory Council includes representatives from Lee County Human Services, Florida Department of Children and Families-Substance Abuse and Mental Health Office, Mental Health Court, Office of the Public Defender, the State Attorney Office, the Lee County Sheriff's Office, Lee County Jail's mental health/medical provider group, and the mental health consumer population. Research indicates that prolonged incarceration and increased mental health symptoms are directly correlated; and in-patient care (jails, hospitals) is more costly than community-based treatment. The county coordinated the effort in partnership with the Ruth Cooper Center. The Lee County project was selected by NACo as one of the five funded in the country. NACo is the only national organization representing county governments in the United States. Its goals are to improve county government, act as a liaison with other levels of government, present the county position on national issues and advance public understanding of the role of counties. ------------------------------------------------------------------ Final Report History of Project Based on evidence that pretrial services plays an essential role in successfully diverting individuals with severe and persistent mental illnesses (including those with co-occurring substance use disorders), Lee Mental Health d.b.a. Ruth Cooper Center implemented the Pretrial Outreach Project as an adjunct to its existing Diversion Program. Lee County, Florida is a rapidly growing community with a significant number of transient individuals. The Lee County Jail continues to report a significant increase in the number of individuals incarcerated who have a mental illness. In response to these demographics, the local community mental health center, the Ruth Cooper Center, formed the Forensic Mental Health Advisory Council, which is a comprehensive and influential group of stakeholders with the common goal of improving systemic barriers to increasing diversions and effectively using community resources. Further, the Ruth Cooper Center developed a Diversion Program. The Diversion Program is intended to divert individuals with serious mental illnesses (including persons with co-occurring substance use disorders) from unnecessary institutionalization and/or criminalization. Specifically, this program is designed to serve individuals with criminal charges in which a severe and persistent mental illness may complicate the legal proceedings. The two primary objectives of the Diversion Program are: 1) to expedite resolution of legal issues and 2) to reduce recidivism. In essence, the Diversion Program serves as a bridge between the Criminal Justice and Mental Health Systems. The primary activities of the existing Diversion Program are to 1) monitor and advocate for persons with felony charges who are at risk or have been adjudicated Incompetent to Proceed (ITP) with trial and/or Not Guilty by Reason of Insanity (NGRI) pursuant to Florida Statute 916, 2) provide community-based supports, such as case management, basic living skills training, and social skills training to individuals in the community, 3) train individuals around legal competency issues pursuant to Florida Statute 916 (offered to individuals in jail and in the community, depending on the person's situation), and 4) identify diversion opportunities and make subsequent recommendations to the Courts, advocating for the least restrictive alternatives when appropriate. The goals of the Pretrial Outreach Project included the enhancement of a collaborative relationship with Pretrial Services and identification of opportunities for diversion of the targeted population at jail intake by assisting in the development viable release plans that include treatment. The Pretrial Outreach Project broadened the scope of activities and opportunities in order to creatively divert individuals from jail (and forensic state hospitals) at all levels of the legal system. Project Planning Process It was clear that neither entity fully understood the other's role and goals. All agreed that working together would be valuable, and that the Diversion Program staff should observe the intake process of Pretrial Services to determine how mental health services might offer maximum benefit to the goal of increasing appropriate diversions. It was during this meeting that Pretrial announced the potential for going to 24/7 service during the grant year. It was understood that developing a 24/7 service would required significant flexibility with the services provided in under the Pretrial Outreach Project. Furthermore, transitioning to 24/7 would change the entire system and offer opportunity to improve screening for mental health issues during the Pretrial intake process. Project Implementation Next, the Diversion Program Supervisor and Competency Restoration Trainer observed the Pretrial intake process and developed a PowerPoint training to offer to the Pretrial Officers over several weeks. During this time, Pretrial Services transitioned to a 24/7 service, delaying collaboration on specific cases. We were able to provide some input into the development of questions to assist in standardizing questions/tools used to screen for potential mental health complications during Pretrial Service's intake process in an effort to improve identification of targeted population. It was not until May that we were able to reconvene. At that point, we presented the training to all of the new Pretrial Officers hired to accommodate the 24/7 services. Upon completion of the training phase, the number of referrals was far less than anticipated. Diversion Program staff worked with key members of Pretrial Services to determine the barriers to referrals. A collaborative decision was made to have the Diversion Program observe the Pretrial process again based on changes made during transition to 24/7. Furthermore, the need to clarify the targeted population to promote referrals due to overlap with the local Mental Health Court became apparent. This new approached proved successful and, once the entities clarified who should be referred to the Diversion Program, the experience of working together drove a more broad range of referrals over time. Diversion Program staff screened all referrals, offering options for and pursuing diversions as appropriate. Diversions generally occurred by linking the individuals with recommended services based on assessment and negotiations with the Court. In two cases, the Project resources allowed the Diversion Program the opportunity to pilot the HCR-20 Violence Risk Assessment to support diversions. Results/Outcomes Our second measurable goal was to incorporate Pretrial Services representation into the Forensic Mental Health Advisory Council (meeting minutes attached). This goal was achieved early on. The addition to the Council is just one example of the relationship between the Diversion Program and Pretrial Services, which is a direct outcome of this project. Moreover, this relationship has been very beneficial to other Diversion Program activities, suggesting that many of the other diversions resulting from existing program services may have been influenced by collaboration with Pretrial Services. The final measurable goal is that of on-going training provided to Pretrial Services personnel related to mental health services and diversion concepts/opportunities. In addition to the three formal trainings provided over the course of the grant year (for which the presentation evaluations forms are attached), the Diversion Program provides less formal education to Pretrial Services related to available services and diversion concepts/opportunities specific to mental illness during interactions related to individual cases and also through the Forensic Mental Health Advisory Council. However, it should be noted that this education is mutual, as the Diversion Program continues to improve understanding of the local justice system through interaction with Pretrial personnel. Lessons Learned What became equally evident are the obstacles resulting from the length of time spent and the level of complexity in trying to navigate the legal system to facilitate a diversion. The Diversion Program is not nave to the challenges inherent in trying to penetrate this system from the outside because the existing services exist to confront that very barrier. However, adding this new point of access to the Diversion Program services uncovered a new level of complexity. Originally, identification was the primary problem. Now, finding those who need help is not the biggest problem; rather, the barrier is often bringing a release plan to fruition or finding appropriate community resources to offer a viable alternative to incarceration in the first place. Getting all involved parties on board with a diversion plan and moving it along is difficult in and of itself, but doing so at intake offers a number of new barriers. For example, at that early stage the defendant often does not have an attorney, so facilitation of a diversion is reliant on Diversion Program staff and Pretrial Services alone. Even with years of experience and a positive reputation of assisting in the Court's efforts to uphold the safety of the community, diversions take a long time from identification to getting the person out of the jail. Future Plans/Sustainability For that reason, the Diversion Program continues to identify and pursue opportunities to secure additional funding to build upon existing services. Doing so is one part of the strategic plan for the Ruth Cooper Center and essential to success in serving the targeted population. The benefits of spending the past year developing a relationship and working with Pretrial Services to address a variety of cases are absolutely sustainable. Furthermore, the Forensic Mental Health Advisory Council hopes to continue to benefit from the valuable input provided by Pretrial Services personnel. Replication The primary requirements of attempting to reproduce the project include a level of interest and awareness of the increasing incarceration of individuals with mental illness on the part of the Criminal Justice and Mental Health Systems along with a willingness to learn from one another. Obviously, funding is needed to spend time developing the relationships and providing education. Project Contact Information Tessa Tayyab, MPA Diversion Program Supervisor Lee Mental Health d.b.a. Ruth Cooper Center 2789 Ortiz Avenue Fort Myers, FL 33919 (239) 791-1543 |